A First View of the Effect of a Trial of Early Mobilization on the Muscle Strength and Activities of Daily Living in Mechanically Ventilated Patients With COVID-19

Objective: To retrospectively investigate the effect of early mobilization on the muscle strength and activities of daily living in patients with COVID-19 under mechanical ventilation. Design: This was a single-center, retrospective, observational study. Setting: Inpatient rehabilitation care in Japan. Participants: The study subjects were divided based on the onset of mobilization: under mechanical ventilation (n=17; aged 68.5±11.9, 13 male) and after extubation (n=11; aged 59.7±7.1, 6 male; N=28). Interventions: Mobilization, including dangle sitting, standing, walking, and muscle strengthening exercises. Main Outcome Measures: The outcome measures were Barthel Index, Medical Research Council Manual Muscle Test, and intensive care unit Mobility Scale. Results: The difference in the Barthel Index, Medical Research Council Manual Muscle Test, and intensive care unit Mobility Scale scores pre- and postintervention were not statistically significant between the 2 groups, but all significantly improved after the intervention. Conclusion: This small sample size study found no difference in the functional recovery of patients with severe COVID-19 who underwent early mobilization under mechanical ventilation relative to when it was begun after extubation

The Kiloparsec-scale Neutral Atomic Carbon Outflow in the Nearby Type-2 Seyfert Galaxy NGC 1068: Evidence for Negative AGN Feedback

Active galactic nucleus (AGN) feedback is postulated as a key mechanism for regulating star formation within galaxies. Studying the physical properties of the outflowing gas from AGN is thus crucial for understanding the co-evolution of galaxies and supermassive black holes. Here we report 55 pc resolution ALMA neutral atomic carbon [CI] $^3P_1\text{-}^3P_0$ observations toward the central 1 kpc of the nearby type-2 Seyfert galaxy NGC 1068, supplemented by 55 pc resolution CO($J=1\text{-}0$) observations. We find that [CI] emission within the central kpc is strongly enhanced by a factor of $>$5 compared to the typical [CI]/CO intensity ratio of $\sim$0.2 for nearby starburst galaxies (in units of brightness temperature). The most [CI]-enhanced gas (ratio $>$ 1) exhibits a kpc-scale elongated structure centered at the AGN that matches the known biconical ionized gas outflow entraining molecular gas in the disk. A truncated, decelerating bicone model explains well the kinematics of the elongated structure, indicating that the [CI] enhancement is predominantly driven by the interaction between the ISM in the disk and the highly inclined ionized gas outflow (which is likely driven by the radio jet). Our results strongly favor the "CO dissociation scenario" rather than the "in-situ C formation" one which prefers a perfect bicone geometry. We suggest that the high [CI]/CO intensity ratio gas in NGC 1068 directly traces ISM in the disk that is currently dissociated and entrained by the jet and the outflow, i.e., the "negative" effect of the AGN feedback.Comment: 12 pages, 5 figures, accepted for publication in The Astrophysical Journal Letter

Near-Earth plasma sheet boundary dynamics during substorm dipolarization.

We report on the large-scale evolution of dipolarization in the near-Earth plasma sheet during an intense (AL ~ -1000 nT) substorm on August 10, 2016, when multiple spacecraft at radial distances between 4 and 15 R E were present in the night-side magnetosphere. This global dipolarization consisted of multiple short-timescale (a couple of minutes) B z disturbances detected by spacecraft distributed over 9 MLT, consistent with the large-scale substorm current wedge observed by ground-based magnetometers. The four spacecraft of the Magnetospheric Multiscale were located in the southern hemisphere plasma sheet and observed fast flow disturbances associated with this dipolarization. The high-time-resolution measurements from MMS enable us to detect the rapid motion of the field structures and flow disturbances separately. A distinct pattern of the flow and field disturbance near the plasma boundaries was found. We suggest that a vortex motion created around the localized flows resulted in another field-aligned current system at the off-equatorial side of the BBF-associated R1/R2 systems, as was predicted by the MHD simulation of a localized reconnection jet. The observations by GOES and Geotail, which were located in the opposite hemisphere and local time, support this view. We demonstrate that the processes of both Earthward flow braking and of accumulated magnetic flux evolving tailward also control the dynamics in the boundary region of the near-Earth plasma sheet.Graphical AbstractMultispacecraft observations of dipolarization (left panel). Magnetic field component normal to the current sheet (BZ) observed in the night side magnetosphere are plotted from post-midnight to premidnight region: a GOES 13, b Van Allen Probe-A, c GOES 14, d GOES 15, e MMS3, g Geotail, h Cluster 1, together with f a combined product of energy spectra of electrons from MMS1 and MMS3 and i auroral electrojet indices. Spacecraft location in the GSM X-Y plane (upper right panel). Colorcoded By disturbances around the reconnection jets from the MHD simulation of the reconnection by Birn and Hesse (1996) (lower right panel). MMS and GOES 14-15 observed disturbances similar to those at the location indicated by arrows

Cervico-shoulder dystonia following lateral medullary infarction: a case report and review of the literature

Abstract Background Secondary cervical dystonia is induced by organic brain lesions involving the basal ganglia, thalamus, cerebellum, and brain stem. It is extremely rare to see cervical dystonia induced by a medullary lesion. Case presentation We report a case of an 86-year-old Japanese woman who developed cervical dystonia following lateral medullary infarction. She developed sudden-onset left upper and lower extremity weakness, right-side numbness, and dysarthria. Brain magnetic resonance imaging revealed an acute ischemic lesion involving the left lateral and dorsal medullae. A few days after her stroke, she complained of a taut sensation in her left neck and body, and cervico-shoulder dystonia toward the contralateral side subsequently appeared. Within a few weeks, it disappeared spontaneously, but her hemiplegia remained residual. Conclusions To date, to the best of our knowledge, there has been only one reported case of cervical dystonia associated with a single medullary lesion. It is interesting to note the similarities in the clinical characteristics of the previously reported case and our patient: the involvement of the dorsal and caudal parts of the medullary and associated ipsilateral hemiplegia. The present case may support the speculation that the lateral and caudal regions of the medulla may be the anatomical sites responsible for inducing cervical dystonia

A comparison of the hemodynamic responses between fentanyl and fentanyl-remifentanil in total intravenous anesthesia for orthognathic surgery

Background: The purpose of this retrospective study was to examine whether total intravenous anesthesia (TIVA) with fentanyl-remifentanil has potential hemodynamic advantages over that with fentanyl alone in orthognathic surgery. Methods: The subjects were 42 generally healthy patients who underwent orthognathic surgery under TIVA using propofol and opioids. Nineteen patients received fentanyl alone (F group), and 23 received fentanyl and remifentanil (FR group) as narcotic analgesics. The factors investigated included arterial blood pressure (ABP), heart rate, the lability index (L.I.) of ABP, number of case that required ephedrine and hypotensive anesthesia. The data between the two groups were compared using the Student’s t-test or Fisher’s exact test. Results: The ABP during anesthesia was significantly lower in the FR group than in the F group. The L.I of the ABP in the FR group was significantly lower than in the F group. The total dose of nitroglycerin for hypotensive anesthesia in the FR group was significantly smaller than that in the F group. The number of cases that required ephedrine was significantly higher in the F R group than in the F group, but hypotension that required administration of ephedrine easily improved, and no refractory hypotension was observed. Conclusion: Total intravenous anesthesia with fentanyl-remifentanil provides superior hemodynamic stability without unacceptable changes in the intraoperative AB